1. Field of the Invention
The invention concerns a medical laser adapted to be controlled remotely from the main operating console, and more particularly, a handpiece held by the surgeon which includes one or more remote controls for actuating and controlling the operation of a medical laser.
2. Description of the Related Art
Medical lasers were first used in ophthalmology for diabetic retinophthalmology. In this procedure the ophthalmologist uses one hand to hold a lens on the patients eye and the other hand to work a slip lamp. Since both hands are occupied, the laser system is activated via a switch built into a foot pedal.
Even today, medical lasers as used in dermatologic and reconstructive and plastic procedures are activated by foot pedals. Examples of foot pedal systems for controlling medical lasers and surgical implements can be found in U.S. Pat. No. 4,862,886 (Clarke et al.) teaching a laser therapy system for laser angioplasty wherein an excimer laser having a coherent beam of ultraviolet radiation is operated via a foot pedal; U.S. Pat. No. 5,568,859 (Levy et al.), directed to a compact sized foot switch for control of medical laser surgery systems; U.S. Pat. No. 5,554,894 (Sepielli) teaching a complex footswitch for ophthalmic surgery including a rotatable foot pedal, a spring member which biases the foot pedal to resist rotation and an adjustment mechanism for adjusting the bias of the spring member to a surgeon selected value; U.S. Pat. No. 5,166,513 teaching a dual actuation photoelectric foot switch for a medical laser; and U.S. Pat. No. 5,580,347 (Reimels) teaching a system for performing surgery on a patient's eye including a handpiece, a control module, and a foot pedal, with processing circuitry located in the foot pedal rather than in the control module.
As demonstrated by these patents, the conventional thinking in this industry is that medical instruments, and particularly medical lasers, are to be activated via a foot pedal.
Cosmetic laser surgery has advanced significantly in recent years. In early laser systems a surgeon performed skin ablation by activating a foot pedal one time each time he desired to fire a laser to treat one small area or "spot". After treating one spot the surgeon repositioned the laser to lay down the next spot perfectly positioned beside the previous spot. An experienced surgeon could lay down as many as three spots per second, evenly spaced and not overlapping. Thousands of spots may be required to give skin an even treatment.
The development of the computer pattern generator (CPG) revolutionized the speed and control of laser surgery. This device attaches to the distal end of a laser articulated arm and is contained within a plastic housing or handpiece held in the hand(s) of the surgeon. As the laser beam goes through the articulated arm and passes through the CPG it is reflected by a tiny mirror controlled by a computer. The mirror aims the laser beam so that it can lay down patterns of spots, for example 81 spots in a 9.times.9 square pattern in a half a second. Every time the foot pedal is activated, the surgeon can lay down 81 spots in a perfect pattern. Then, all the surgeon needs to do is line up the next square beside the previous square, activate the laser, and hold the CPG steady as it fires and lays down each successive pattern of 81 spots.
The CPG can lay down not only a square pattern, but can be programmed to lay down, e.g., a single spot, a row of spots, two rows of spots, a triangle pattern, a circular pattern, etc. Thus, if during the course of a surgical procedure the surgeon notices that he skipped a narrow strip of skin, he may stop laying down broad 9 by 9 square patterns and reprogram the CPG to lay down a 1 by 9 pattern or a 2 by 9 strip pattern to fill in the missed strip. However, in practice, a surgeon will develop a rhythm. This is important, since skin will heat up when being lased, and the temperature of skin influences the rate of ablation. A rhythmic treatment of skin will ensure even heating of adjacent skin. It is difficult for a surgeon to interrupt the flow of the procedure for the amount of time it takes to reprogram the CPG to change the pattern to a 1 by 9.
Instead of reprogramming the CPG, surgeons tend to develop a feel for the foot pedal control of the CPG, and find that it is possible to depress the foot pedal for only a very short fraction of the time needed to generate the full pattern. The surgeon will thus leave the CPG set to generate a 9 by 9 pattern but interrupt the laser activation as soon as the laser laid down the first 1 by 9 or a 2 by 9 pattern.
While it may be possible for a surgeon with fast foot control to limit the CPG to laying down one or two rows of spots, it is nearly impossible to control a CPG to lay down only a single spot. Thus, some reprogramming of the CPG during some time in the procedure will inevitably be necessary.
The laser system can be programmed to select for various pattern sizes, pattern shapes (some systems having 79 preprogrammed patterns, energy, power, pulse or continuous wave, and pulse rate. Further, as a safety feature, and so that the laser is not left energized unnecessarily, the laser system is switchable between a "ready" mode and a "standby" mode. Since the surgeon is wielding the laser handpiece and is far from the control console, each change in setting requires the surgeon to request the console operator to enter the change of settings. Then, to verify that the desired settings were correctly entered, the surgeon must turn around, look at the display console or console mast display, then turn back to the patient and resume work. This tends to disrupt the flow of a surgical procedure.
As surgeons get accustomed to using the CPG, problems surface. One surgeon found that the CPG required her to stand all day on one foot, supporting all her weight on this foot, in order to be able to control the laser with her other foot. This surgeon suffered back pain because of the awkward position she was forced to stand in. Some surgeons perform this type of surgery 8 hours a day and for them this uncomfortable posture becomes a real problem. It is of course possible to perform the surgery while sitting, but for ergonomic reasons it becomes more awkward to use the foot to control the laser; thus, standing is the conventional position for the surgeon.
Another problem with the existing system is that the foot pedal and foot pedal cord are always in the way. Many surgeons find the foot pedal cord to be a serious inconvenience. If the surgeon begins a cosmetic procedure on one side of a patient's face and wants to move to the other side of the patient, he must reposition the foot pedal and cord. This tends to be such a hassle that surgeons instead lean over the patient to work on the other side of the patient rather than moving the equipment, the foot pedal, and the foot pedal cord to the other side of the patient.
Yet another problem with the traditional foot pedal arrangement is that in the surgical theater, particularly in OB/GYN urology, the floor frequently becomes wet. Laser manuals warn the practitioner to discontinue use of the laser under such conditions, since the foot switch is liable to short circuit.
At least one company, Storz Instrument Company of St. Louis, Mo. (Storz), had recognized that there is, on the part of a number of surgeons, a desire to have a more "hands-on" control over the surgical equipment control systems they use. It was recognized that in, for example, a typical ophthalmic operation, a surgeon often has the assistance of a scrub nurse and a circulating nurse, and sometimes others. The surgeon spends much time peering through a binocular microscope to obtain a magnified view of the eye being operated upon. Thus, the surgeon typically requests assistance from the nursing staff for activity such as changing pressures, power levels, and cut rates, raising or lowering the IV bottle containing the saline solution used to irrigate the eye, and changing the control modes of the equipment. Under some circumstances, such as a cataract operation where an emergency vitrectomy must be performed, the surgeon may well be involved in completing one task, such as a phacoemulsification procedure, while the other members of the surgical team are busy setting up for a different surgical procedure, such as a vitrectomy. Storz recognized that it would be extremely useful if the surgeon could be provided with a remote control console for controlling the surgical equipment, particularly one which could provide most of the functionality of the main control console.
Such a remote console is in fact disclosed in U.S. Pat. No. 5,249,121 (Baum et al). However, even though this patent teaches in great depth how to provide a remote console for changing settings on a main console, it continues to use a foot pedal control to operate surgical instruments. Further, there is no mention of a medical laser system.
Another problem, briefly alluded to above, is the problem of providing the surgeon with laser system status information during surgery. Conventional displays include LCD, LED, video and/or CRT displays mounted on a console which is usually behind the back of the surgeon during surgery. To view the data appearing on the display for purposes of changing settings, the surgeon must take his eyes of the patient, loose rhythm and concentration, turn around to read the display, order changes in settings, turn back to the patient, then return to the display to confirm entry of the correct settings, and turn back to patient. Furthermore, the loupe worn by the surgeon can make it more difficult for him to turn and view the console. Also, a surgeon commonly becomes preoccupied with the current task, and he may simply forget to constantly review the important safety data provided on the display.
There is thus a need for an improvement in the laser control system which overcomes the above problems, and it is an object of the present invention to provide such improvements.